scholarly journals Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices

2021 ◽  
Vol 10 (16) ◽  
pp. 3623
Author(s):  
Stéphane Manzo-Silberman ◽  
Christoph Nix ◽  
Andreas Goetzenich ◽  
Pierre Demondion ◽  
Chantal Kang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Ventricular Assist ◽  
Ventricular Ejection Fraction ◽  
Assist Devices ◽  
Significant Difference ◽  
Left Ventricular Assist

Introduction: Despite the improvements in standardized cardiopulmonary resuscitation, survival remains low, mainly due to initial myocardial dysfunction and hemodynamic instability. Our goal was to compare the efficacy of two left ventricular assist devices on resuscitation and hemodynamic supply in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Seventeen anaesthetized pigs had 12 min of untreated VF followed by 6 min of chest compression and boluses of epinephrine. Next, a first defibrillation was attempted and pigs were randomized to any of the three groups: control (n = 5), implantation of an percutaneous left ventricular assist device (Impella, n = 5) or extracorporeal membrane oxygenation (ECMO, n = 7). Hemodynamic and myocardial functions were evaluated invasively at baseline, at return of spontaneous circulation (ROSC), after 10–30–60–120–240 min post-resuscitation. The primary endpoint was the rate of ROSC. Results: Only one of 5 pigs in the control group, 5 of 5 pigs in the Impella group, and 5 of 7 pigs in the ECMO group had ROSC (p < 0.05). Left ventricular ejection fraction at 240 min post-resuscitation was 37.5 ± 6.2% in the ECMO group vs. 23 ± 3% in the Impella group (p = 0.06). No significant difference in hemodynamic parameters was observed between the two ventricular assist devices. Conclusion: Early mechanical circulatory support appeared to improve resuscitation rates in a shockable rhythm model of cardiac arrest. This approach appears promising and should be further evaluated.

scholarly journals Pheochromocytoma-Induced Atrial Tachycardia Leading to Cardiogenic Shock and Cardiac Arrest: Resolution with Atrioventricular Node Ablation and Pacemaker Placement

2014 ◽  
Vol 41 (6) ◽  
pp. 660-663 ◽  
Author(s):  
Hassan Shawa ◽  
Mandeep Bajaj ◽  
Glenn R. Cunningham
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Atrioventricular Node ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Ventricular Assist ◽  
Ventricular Ejection Fraction ◽  
Pacemaker Placement ◽  
Temporary Pacemaker

Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias. A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, &lt;0.15) that did not respond to the placement of an intra-aortic balloon pump. A TandemHeart® Percutaneous Ventricular Assist Device was inserted emergently. After atrioventricular node ablation and placement of a temporary pacemaker, the TandemHeart was removed. Computed tomography of the abdomen revealed a pheochromocytoma. After placement of a permanent pacemaker, the patient underwent a right adrenalectomy. This is, to our knowledge, the first reported case of pheochromocytoma-induced atrial tachyarrhythmia that led to cardiogenic shock and cardiac arrest unresolved by the placement of 2 different ventricular assist devices, but that was completely reversed by radiofrequency ablation of the atrioventricular node and the placement of a temporary pacemaker. We present the patient's clinical, laboratory, and imaging findings, and we review the relevant literature.

Improved Biocompatibility of Heparin Surface-Coated Ventricular Assist Devices

1992 ◽  
Vol 15 (5) ◽  
pp. 301-306 ◽  
Author(s):  
L.K. Von Segesser ◽  
B.M. Weiss ◽  
E. Hänseler ◽  
B. Bisang ◽  
B. Leskosek ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Control Group ◽  
Total Occlusion ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Heparin Coating ◽  
Significant Difference ◽  
Left Ventricular Assist ◽  
Baseline Values

Heparin surface coated ventricular assist devices (VADs) and cannulas were evaluated in comparison to uncoated VADs in 10 bovine experiments (body weight 77 ± 6 kg). All systems were primed with cristalloid solution. No systemic heparin was given. Left ventricular assist was started with a blood flow of 4.2 ± 0.4 l/min and maintained over 6 hours. Besides hemodynamic monitoring, blood samples were taken at regular intervals for blood gas, hematological, biochemical and coagulation studies. All animals in the study group (coated) were assisted for the scheduled 6 hours without device failure. In the control group, however, total occlusion occurred in 1 VAD after 1 hour of left ventricular assist whereas the other 4 VADs remained functional throughout the protocol. Mixed venous oxygens saturation was preassist 56 ± 12% for coated versus 63 ± 11% for uncoated and the final value at 60 minutes after weaning was 58 ± 16% versus 59 ± 5% (NS). Mean hematocrit dropped from a baseline value of 33 ± 4% for coated versus 29 ± 8% for uncoated to 29 ± 7% versus 30 ± 5% (NS) after 6 hours of assist. There was no significant difference between the baseline values (5.7 ± 3.0/jmol/l for coated versus 4.6 ± 3.1/umol/l for uncoated) and the 6-hour values (3.8 ± 3.7/umol/l versus 7.6 ± 6.4/jmol/l) for mean plasma hemoglobine. The normalized platelet levels dropped after 10 minutes of assist to 91 ± 21% for coated versus 94 ± 49% for uncoated (NS) and 89 ± 29% versus 65 ± 44 at 6 hours (NS). The activated clotting time evolved from a baseline value of 127 ± 12 s for coated versus 131 ± 5 s for uncoated (NS) to 122 ± 17 s versus 139 ± 18 s at 60 minutes after assist (NS). Renal embolus score showed a mean level of 11 ± 8 for coated versus 15 ± 12 for uncoated. The VAD clot score showed a mean level of 0.2 ± 0.4 for coated versus 2.2 ± 1.6 for uncoated (p < 0.5). We conclude, that heparin coating of blood exposed surfaces provides significant improvement of VAD biocompatibility.

Abstract 17337: The Effect of Digoxin on Hemocompatibility Related Adverse Events in Patients With Durable Left Ventricular Assist Devices

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isabel Balachandran ◽  
Kevin Kennedy ◽  
Jose Nunez ◽  
Wilson Grandin ◽  
Arthur R Garan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Significant Difference ◽  
Left Ventricular Assist

Introduction: Hemocompatibility-related adverse events (HRAE) including stroke, pump thrombosis, and gastrointestinal bleeding (GIB), is a major cause of mortality in patients with continuous flow left ventricular assist devices (CF-LVAD). Digoxin (dig) is used in treatment of advanced heart failure, and has been implicated in decreasing angiogenesis via HIF-alpha/TGF inhibition. There is conflicting data regarding the effect of dig on GIB rates in patients with cf-LVADs. We investigated the association of dig use in patients implanted with CF-LVADs with HRAE with both centrifugal and axial flow devices. Methods: 12,002 patients from the INTERMACS registry implanted with cf-LVADs between 2012-2017 and were alive at 1-month were included. The event rates of HRAE at 1-yr post implant were compared in patients with or without dig use at 1-month post implant. Cox proportional hazards modeling was used to assess the independent association of dig use and HRAE. Results: There was no significant difference in age, sex, race, Cr, INR, DM, and AST in those who were prescribed vs. not prescribed dig at 1 month. On univariate analysis, dig was associated with decreased HRAE in patients with CF-LVADs at 1-year post implantation (37% vs 41%, p<0.01) (Fig. 1) however this was primarily driven by decreased neurologic events. There was no association with GIB (p 0.18). On multivariate analysis, dig was not found to be an independent predictor of HRAE (HR 0.95, 95% CI 0.89-1.02, p 0.2) (Figure 2). Conclusions: Despite previous smaller studies which suggested a decreased risk of HRAE and GIB in patients with cf-LVADs, we found that dig was not an independent predictor of HRAE.

Sign in / Sign up

Export Citation Format

Share Document